“I still don’t know what I was waiting for
And my time was running wild
A million dead-end streets
And every time I thought I’d got it made
It seemed the taste was not so sweet
So I turned myself to face me…”
-David Bowie
Let’s talk about psychotherapy and change. Although I don’t think David Bowie was talking about psychotherapy when he released the song Changes in 1971, his lyrics could certainly describe the thought process of someone considering engaging in the therapy process. In my experience as a therapist, there are two reasons why people come to therapy: because they want to make a change in their life or because someone else wants them to make a change in their life. These differing reasons will color the therapeutic process and outcome.
Each of us approaches change in different ways although there are consistencies in the process. In 1982, James O. Prochaska, Carlo Di Clemente and colleagues developed a model of change, based on the analysis, and use of several theories of psychotherapy. The core concept of the model is that therapeutic progress is made through a series of stages related to change. Let’s look at the stages:
The first is known as the Precontemplation Stage. The person in this stage of change often doesn’t see the problem. Think about a time when someone in your family or at work approached you with something they were concerned about. If you did not see the problem, you may have been in the precontemplative stage of change. In this stage, responsibility for the situation is placed on other people, society, or fate. The person feels there is no hope for changing the situation because they are not in control of it. This person usually comes to therapy because of pressure from a partner, parent, employer, the court, or other outside entity.
“I want to stop feeling so bad.” This thinking begins the Contemplation Stage of change. The person in this stage acknowledges there is a problem and has begun to think about how to solve it. Contemplators try to understand their problems by looking for causes and pondering possible solutions. They often have identified a goal but the plans to get there are not well defined. While desiring change, they are not ready to begin the change journey. The transition to the next stage of change is marked by the person beginning to think more about the future than the past, to anticipate change, to think about activities needed to change and feeling anxiety and excitement about changing.
Following contemplation of change is the Preparation Stage. Most people in this stage are making concrete plans to act. They may still need support and some convincing due to the remaining mixed feelings about making the change.
Here we go! The Action Stage is where people make their move to make the change they have been preparing for. They modify their behavior and surroundings. Taking action requires a great commitment of time and energy. This is when the change becomes more visible to others.
Change never ends with action. The final stage in the change process is known as the Maintenance Stage. To maintain the change we have committed to requires commitment to the result and the steps required.
It is not uncommon within the change process to relapse and return to earlier stages. Most people who successfully make changes in their life will go through the stages three or four times before they make it to the Maintenance Stage without a slip up. Instead of viewing relapse as a problem, it may be helpful to view it as an opportunity to learn and practice new skills or ways of behaving, to develop competence within the change.
Psychotherapy with someone in the Precontemplative Stage of change can be frustrating for both the therapist, the person attending therapy and the person wanting the change. At some point, if the external motivation does not become internalized, change is unlikely to occur no matter how many sessions the person attends. On the other hand, therapy can be immensely helpful for those people who are in the Contemplation Stage or later. Psychotherapy can provide a different perspective, options that the person was unaware of, skills and support. Change can be difficult but developing positive mental health often requires change and will be worth it in the long run.
If you want more information on the change process, you might want to check out the book Changing for Good: A Revolutionary Six-Stage Program for Overcoming Bad Habits and Moving Your Life Positively Forward by James O. Prochaska and John Norcross.
Reference: Prochaska, James O. and Di Clemente, Carlo C. TRANSTHEORETICAL THERAPY: TOWARD A MORE INTEGRATIVE MODEL OF CHANGE. Psychotherapy: Theory, Research and Practice. Volume 19 #3. Fall, 1982.
